Utility Of Colonoscopy Research Articles

Factors Affecting Colorectal Cancer Screening in Primary Care Physician Practices in Ukraine.

This study aims to identify the factors influencing colorectal cancer (CRC) screening practices, along with the barriers and facilitators from the perspective of primary care physicians (PCPs) in Ukraine. Considering health care system challenges, including those posed by the ongoing war, this research seeks to inform improvements in CRC screening and outcomes in Ukraine and other low- and middle-income countries (LMICs). A survey was designed and distributed electronically to Ukrainian PCPs, focusing on CRC screening practices, beliefs, and barriers. The survey incorporated questions adapted from established cancer screening surveys and frameworks. Complete responses were collected from 740 PCPs. Sample statistics were computed, and population-level perceptions and associations with CRC screening practices were estimated by standardizing responses to national PCP demographics. The majority of respondents were women (91%) and specialized in family medicine (84%). Respondents believed in the effectiveness of colonoscopy for reducing CRC mortality (80%), with 75% of PCPs referring patients for this screening modality. Major barriers identified include inadequate training of PCPs in screening and lack of resources. Respondents reported high utilization of fecal occult blood test and colonoscopy for screening when these tests were said to be available in their practices. Self-reported familiarity with CRC screening guidelines and participation in educational workshops were positively associated with screening referrals. The study highlights the role of access to CRC screening tests and awareness of screening guidelines in enhancing CRC screening practices among Ukrainian PCPs. Addressing training and resource barriers, alongside public health interventions targeting patient-related barriers, is essential. These findings offer valuable insights for LMICs facing similar challenges, emphasizing the need for tailored strategies to improve cancer screening in these health care settings.

Utility of Colonoscopy for the Screening and Management of Cervical Cancer in Africa: A Cross-Sectional Analysis of Providers' Training and Practices

Utility of Colonoscopy for the Screening and Management of Cervical Cancer in Africa: A Cross-Sectional Analysis of Providers' Training and Practices

How COVID-19 Impacted Colonoscopy Utilization and Colorectal Cancer Detection in Hawai'i in 2020.

The Coronavirus Disease of 2019 (COVID-19) pandemic had a profound impact on colorectal cancer (CRC) screening and diagnostic testing. During the initial months of the pandemic, there was a sharp decline in colonoscopies performed as many areas were on lockdown and elective procedures could not be performed. In later months, even when routine procedures started being scheduled again, some patients became fearful of contracting COVID during colonoscopy or lost their health insurance, leading to further delays in CRC diagnosis by colonoscopy. Previous studies have reported the dramatic decrease in colonoscopy rates and CRC detection at various institutions across the country, but no previous study has been performed to determine rates of colorectal screening by colonoscopy in Hawai'i where the demographics of CRC differ. The team investigated the pandemic's impact on colonoscopy services and colorectal neoplasia detection at several large outpatient endoscopy centers in Hawai'i and also classified new CRC cases by patient demographics of age, sex, and ethnicity. There were fewer colonoscopies performed in these endoscopy centers in 2020 than in 2019 and a disproportionate decrease in CRC cases diagnosed. Elderly males as well as Native Hawaiians/Pacific Islanders were most impacted by this decrease in CRC detection. It is possible there will be an increase in later stage presentation of CRC and eventual CRC related mortality among these patients.

Utilization of colorectal cancer screening tests across European countries: a cross-sectional analysis of the European health interview survey 2018–2020

Colorectal cancer (CRC) screening has been shown to reduce CRC incidence and mortality, and most European countries have started to implement CRC screening programs in the past 20 years. Consequently, this study aimed to estimate the utilization of fecal tests and colonoscopy, as well as investigate factors associated with their utilization based on specific screening program characteristics in European countries. We analyzed data from the European Health Interview Survey 2018-2020 to determine the utilization of fecal tests [guaiac-based fecal occult blood test (gFOBT) or fecal immunochemical test (FIT)] within the preceding 2 years or colonoscopy within the preceding 10 years among people aged 50-74 years, based on the type of screening offered in each country. Using multivariable logistic regression and sub-group meta-analysis, factors associated with screening use were determined. The analyses included data from 129,750 respondents across 29 European countries, with participant counts ranging from 1511 individuals in Iceland to 11,755 individuals in Germany. Unit response rates ranged from 22% to 88%. The use of either test was highest among countries with fully rolled-out programs with fecal tests [from 37.7% (867/2379) in Croatia to 74.9% (2321/3085) in Denmark] and in countries offering colonoscopy as an alternative screening method [from 26.2% (854/3329) in Greece to 75.4% (1192/1760) in Luxembourg]. We observed the lowest utilization of either test in countries with no program or small-scale programs [6.3% (195/3179) in Bulgaria to 34.2% (722/2144) in Latvia]. Across all types of screening offers, younger age, being without a partner, low education, rural residence, and living in large households were associated with lower utilization, as were poor lifestyle scores and prolonged periods without physician consultation. Our findings point to large disparities and much room for improvement in CRC screening offers and utilization across Europe. There was no funding source for this study.

Colonoscopy Utilization in Elderly Patients with Dementia: Characteristics, Complications, and Charges in a National Matched-Cohort Analysis

BackgroundIt is projected that the elderly population will continue to increase. Many will develop chronic conditions such as dementia.AimsOur aims are to describe the utilization of colonoscopy among patients with dementia and compare outcomes in those with and without dementia.MethodsThis population-based analysis utilized the National Inpatient Sample (NIS) during 2019. Patients with dementia over the age of 60 years receiving colonoscopy were identified utilizing ICD-10 codes. Logistic regression was used for propensity score matching between the comparison groups. A Greedy one-to-one matching algorithm was utilized along with standardized mean differences to assess balance. Mcnemar test, signed rank sum, and paired t-test were used to compare the outcomes.ResultsInitially, 50,692 patients without dementia were compared with 4323 patients with dementia. Patients with dementia were more likely to be female, older, less likely White, had lower income, and more likely to be on Medicare. In the matched comparison (4176 in each group), complication analysis showed that patients with dementia did not have higher colonoscopy-related complications. They did have higher rates of other complications including renal/AKI (p = 0.0042), pulmonary/pneumonia (p = 0.003), cerebrovascular accidents (p = 0.0063), and sepsis (< 0.0001). Patients with dementia were also less likely to have routine discharges (< 0.0001), had longer hospital stays (< 0.0001), and higher hospital costs (< 0.0001).ConclusionsElderly patients with dementia have similar colonoscopy-related complications as patients without dementia. However, they do have higher complications in general. The decision whether to perform colonoscopy in this patient population is multifactorial. A careful assessment of a dementia patient’s history can help with this decision.

Lower Gastrointestinal Bleed in Children: Safety, Utility, and Yield of Colonoscopy: an Experience from a Large Tertiary Referral Endoscopy Center

Abstract Objective: There is paucity of data on lower gastrointestinal bleed (LGIB) in the pediatric population. We aimed to retrospectively review the endoscopy findings in patients younger than 18 years, presenting with lower gastrointestinal (GI) bleed and undergoing colonoscopy. Materials and Methods: Retrospective review of the endoscopy database at the department of gastroenterology at a tertiary care center from Western India was conducted between June 2017 until December 2021. Patients ≤18 years with LGIB, who underwent colonoscopy within 7 days of onset of bleed, were included in the study. Demographic details, endoscopic findings, and complications were noted. Results: In all, 55 patients were included in study (65% males; median age: 13 years [range: 1–18 years]). The most common endoscopic findings were polyps in 26 (47.2%) patients, colitis in 15 (27.2%) patients, solitary rectal ulcer syndrome (SRUS) in 6 (11.3%) patients, and hemorrhoids in 3 (5.4%) patients. Five (9%) patients had normal colonoscopy in whom the cause remained unidentified on further evaluation. However, no repeat episode was documented on a follow-up of 30 days. The most common location of a polyp was the rectum (64%). Two patients had multiple polyps (2 each). All the patients underwent a successful polypectomy. Pathology reported juvenile polyps in 25 biopsies. Four were diagnosed as inflammatory bowel disease (IBD), while 11 had acute infective colitis. Patients with infectious colitis as compared to IBD had higher incidence of fever (55 vs. 0%) and lesser incidence of previous similar events (22 vs. 66%). Those with polyps were younger than those without polyps (9.1 vs. 14.3 years; p = 0.000). Polyps were significantly more common in boys (84%; 22/26; p = 0.014) than in girls. No complications occurred in this cohort of patients. Conclusions: Polyps are the most common cause of LGIB in patients ≤18 years, followed by colitis. Polyps were more common in younger males.

Colonic Diverticulosis at Colonoscopy in Africa: A Systematic Review and Meta-Analysis of Pooled Estimates

Introduction: There is need to ascertain any epidemiologic shift of diverticulosis among Africans with traditionally high fiber diet consumption patterns and rare diverticulosis prevalence. Methods: We systematically searched PubMed, Scopus, Cochrane Library, African Journal Online (AJOL), and Google Scholar. Eligibility criteria included full-text observational and experimental human colonoscopy studies on asymptomatic and symptomatic African population from 1985 to 2022. Case reports, conference abstracts, dissertations, systematic reviews, and studies lacking colonoscopy findings were excluded. NIH quality assessment tool for observational cohort and cross-sectional studies was used to assess risk of bias. Meta-analysis was performed using the random-effect model. Heterogeneity was assessed using inconsistency (I2) statistics. Results: Thirty studies were included. Pooled prevalence rate of colonic diverticulosis in the last decade (2012–2022) has increased to 9.7% (95% CI 6.5–13.4; I2 = 97.3%) from 3.5% (95% CI 1.4–6.4; I2 = 62.7%). The highest regional prevalence rate was in West African studies at 11.3% (95% CI 7.6–14.9; I2 = 96.2%). Proportion of individuals with diverticulosis ≥50 years and male sex were 86.9% (95% CI 80.5–92.1) and 65.2% (95% CI 55.0–74.8), respectively. The left colon had the highest diverticulosis frequency (37% [148/400]). Bleeding/inflammation complications were sparingly detected (OR 0.2 [95% CI 0.03–0.75; p < 0.0001]). Conclusion: An increasing utilization of colonoscopy revealed approximately a threefold increase in the prevalence rate of colonic diverticulosis in Africa. This pathology was most common in males aged >50. Left colon was predominantly affected. Further studies are needed to demonstrate the effect of westernization of diet.

Trends in colorectal cancer screening from NHIS survey: Analysis of modalities impact on overall screening.

67 Background: Colorectal cancer (CRC) is the second leading cause of cancer-related mortality among men and women combined in the United States (US). Although the national screening rate has increased over the years, it remains below the target of 80% recommended by the National Colorectal Cancer Roundtable for improved CRC outcomes. In most recent years, and particularly during COVID-19, screening-eligible individuals preferred at-home, non-invasive screening options over invasive tests such as colonoscopy due to convenience and accessibility. The objective of this study was to understand the CRC screening trends over the last two decades, and the impact of various screening modalities on the overall CRC screening rate. Methods: Using National Health Interview Survey (NHIS) data from 2005 onwards, we examined CRC screening (colonoscopy, mt-sDNA, FIT/FOBT, and sigmoidoscopy) rates among adults aged 50-75 years. A pseudo-time-series cross-sectional (pseudo TSCS) analysis was conducted including random effects Generalized Least Square (GLS) regression model to estimate the relative impact of each modality on the overall increase in CRC rates from 2018 to 2021. Results: Among 50-75 years old individuals, the estimated CRC screening use increased by 32% from 2005 to 2021 (47.7% to 69.9%). Between 2018 to 2021, the rates increased from 64% to 70%, driven largely by increased use of mt-sDNA, a 62.1% increase from 2018 to 2021 (2.5% to 6.6%). During this time period, colonoscopy utilization increased by 4.4% (61.2% to 64.0%), while FOBT/FIT utilization increased by 3.6% (5.3% to 5.5%). A pseudo-TSCS analysis showed that mt-sDNA contributed substantially to the overall CRC screening rate increase during years 2018-2021 (77.3%; p &lt; 0.0001). Conclusions: While CRC screening rates are increasing, they remain below the national goal of 80%. Mt-sDNA as a home-based, non-invasive screening, recommended at a 3-year interval, has been leveraged to improve overall CRC screening rates, particularly to address the screening backlog created during the COVID-19 pandemic. A collaborative approach between healthcare providers and screening-eligible individuals is needed to empower patients with choice for their CRC screening modality to achieve the national goal.

Sub-Mucosal Lipoma a Rare Cause of Colonic Obstruction Managed Surgically: Case Series and Literature Review

Sub-mucosal lipomas of the colon, as first described by Bauer in 1757 are fatty tumors, rarely greater than 2 cm in size and hence rarely symptomatic. The vast majority of these tumors are subjected to be found incidentally during a colonoscopy, Computed Tomography (CT) scan, surgery, or autopsy and are most often located in the ascending colon near the cecum. Referred to second most common benign tumour of the colon, sub-mucosal colonic lipomas are often difficult to diagnose because of their asymptomatic nature or the intermittent, non-specific nature of patients’ symptoms. In this domain, development of symptoms manifesting as abdominal pain, hemorrhage, diarrhea, or constipation are most commonly encountered with lipomas of size greater than 2 cm. Furthermore, obstruction secondary to colonic intra-luminal narrowing or intussusception is mostly reserved for larger lipomas, most commonly those growing more than 4 cm in size and hence requiring surgical or endoscopic resection. However, as such lesions are more often being exposed nowadays owing to the enhanced utilization of colonoscopy and CT and the fact that complications can prevail, both rises the need of settling well established guidelines advising the management of such polyps, on the road of preventing consequent complications. In this article and in trial of us addressing this rare entity, shedding the light on its importance and further elaborating on its significant consideration in working up bowel obstructive pathologies, we present a literature review of colonic sub-mucosal lipomas, along with our experience in obstructive colonic lipomas, in a retrospective case series constituted of 4 characteristically and demographically studied patients, along with the management after being admitted to our tertiary care center for obstructive symptoms.

Where you live matters: how degree of urbanization influences healthcare utilization in Portugal

Abstract Background The degree of urbanization is a health determinant, causing inequalities in exposure to risk factors, influencing health services’ territorial organization and enabling healthcare utilization. Since Portugal's proportion of population residing in urban areas is higher than the world average, we aimed to estimate the magnitude of the association between the place of residence's degree of urbanization and healthcare utilization in the country. Methods A cross-sectional study was conducted, using data from the Portuguese 2019 National Health Survey, a multi-stage clustered stratified sample. All participants, aged over 15, were included. Outcomes assessed included: going to general practitioner (n = 14 360) and specialist consultations (n = 14 334), taking a flu vaccine (n = 5 270), undergoing a colonoscopy (n = 9 075), too-long waiting times (n = 12 009) and waiting for healthcare due to distance/transportation (n = 12 117). Crude and adjusted prevalence ratios (aPR) and respective 95% confidence intervals (95%CI) were estimated using Poisson regression models. Results Compared to urban areas, living in less populated areas was significantly associated with waiting for healthcare due to distance/transportation (aPR=1.54, CI95% 1.06-2.24) and lower colonoscopy utilization (aPR=0.86, CI95% 0.78-0.95). Flu vaccination prevalence ratios were significantly higher for rural (aPR=1.15, CI95% 1.03-1.29) and suburban areas (aPR=1.16, CI95% 1.04-1.30) than urban areas. There was no significant association between degree of urbanization and attending general or specialist consultations nor too-long waiting times. Conclusions Healthcare needs are not being met in less populated areas likely due to geographic constraints. Against expectation, flu vaccination might not be optimized in urban areas, which could bring concerns for immunization rates in risk groups. Policies to improve universality and equity in population's access to healthcare are needed. Key messages • Differences in healthcare utilization related to place of residence's degree of urbanization show that universal health coverage is yet to be reached. • Less populated areas are more likely to wait too long to receive healthcare due to distance and mobility hindrances, representing a challenge for health systems which policies should help mitigate.

S342 Utilization of Endocuff-Assisted Colonoscopy and Computer-Aided Detection in Optimizing Colonoscopies in the Elderly

S342 Utilization of Endocuff-Assisted Colonoscopy and Computer-Aided Detection in Optimizing Colonoscopies in the Elderly

Identifying the need for a UK colorectal cancer screening programme for patients with cystic fibrosis (CF): 10-year retrospective review of colonoscopy and colorectal cancer outcomes at a single CF centre

ObjectivePatients with cystic fibrosis (pwCF) have a high incidence of early colorectal cancer (CRC). In the absence of a UK CRC screening programme for pwCF, we evaluated the utility and...

Healthcare utilization among individuals diagnosed with lynch syndrome through a universal germline genetic testing program.

10603 Background: Most individuals with Lynch syndrome (LS) are unaware of their risk. Criteria-based testing will not close this gap as it fails to identify ~50% of mutation carriers. Universal germline testing (GT) for in oncology stands to identify more mutation carriers and advance cancer control. However, the clinical utility of universal germline testing is unknown. Methods: The enterprise-wide City of Hope INSPIRE study offers all consented patients GT for cancer susceptibility (155 genes) and actionable disorders (59 genes). We used an informatics approach to evaluate healthcare utilization for patients found to have MLH1, MSH2, MSH6, PMS2 or EPCAM mutations. We queried codified data elements in our electronic data warehouse before and after GT (post testing interval: 1-29 months). We binned care as possibly related/ not related to HBOC based on NCCN guidelines. Results: Of 10,814 patients who had GT, 80 (0.74%) had a pathogenic/ likely pathogenic mutation in either MLH1, MSH2, MSH6, PMS2 or a 3’ deletion of EPCAM. The demographic distribution of LS patients was: white (n = 51, 64%), Asian (n = 13, 16%), Hispanic (n = 19; 24%); female (n = 51, 64%); the mean age was 54 yrs. Eighty-six percent (n = 69) had cancer, including 45% with cancers associated with LS (colorectal 17%, endometrial 7%, ovarian 6%, esophageal/stomach 5%, bladder/urinary tract 5%, and prostate 5%) and 41% with cancers that are not associated with LS. Fifty-two percent of all LS patients had procedures, imaging, and/or therapy potentially related to their LS diagnosis. As expected, utilization of colonoscopy, EGD, MRCP/EUS, transvaginal ultrasound, and hysterectomy with bilateral salpingo-oophorectomy (HBSO) occurred both before and after testing for the cancer cohort, with the majority of utilization occurring after testing likely related to their Lynch syndrome diagnosis. Twelve (17%) cancer patients with Lynch syndrome received Immune Checkpoint Inhibitor therapies. In the unaffected cohort, rates of utilization were higher prior to testing for transvaginal ultrasound possibly because 2% underwent a HBSO after their diagnosis and no longer required endometrial surveillance. Rates of colonoscopy, EGD, and HBSO were all higher after GT. Conclusions: We found high levels of relevant healthcare utilization for Lynch syndrome gene mutation carriers in the context of universal GT. However, this initial informatics approach is limited because key information on prior GT and motivations for surgery (e.g., therapeutic vs prophylactic HBSO) are not adequately captured in codified data. Codified EHR queries will need to be augmented by text mining and/or manual chart review to fully capture care and assess the clinical utility of system-wide genetic care delivery interventions.

Trends in colorectal cancer screening in the United States, 2012 to 2020.

Despite recommendations to increase the uptake of colorectal cancer (CRC) screening, trends in CRC screening vary with sociodemographic status. We aimed to evaluate trends in CRC screening in the US population and subpopulations. A total of 1,082,924 participants aged 50 to 75 from five cycles (2012, 2014, 2016, 2018, and 2020) of the Behavioral Risk Factor Surveillance System were involved. Multivariable logistic regression models were performed to evaluate linear trends in CRC screening utilization from 2012 to 2018. Rao-Scott chi-square tests were used to assess the differences in CRC screening utilization between 2018 and 2020. The estimated percentage reporting up-to-date with CRC screening increased significantly (P for trend <0.001), from 62.8% (95% CI, 62.4%-63.2%) in 2012 to 66.7% (95% CI, 66.3%-67.2%) in 2018 and 70.4% (95% CI, 69.8%-71.0%) in 2020, in accordance with 2008 US Preventive Services Task Force recommendations. Trends followed similar patterns in most subgroups, although with different magnitudes in several subgroups, primarily those underweight showed a stable percentage over time (P for trend = 0.170). In 2020, 72.4% of participants reported they were up to date with CRC screening, including the utilization of stool DNA tests and virtual colonoscopy. Colonoscopy was the most commonly used test in 2020 (64.5%), followed by FOBT (12.6%), stool DNA test (5.8%), sigmoidoscopy (3.8%), and virtual colonoscopy (2.7%). In this nationally representative survey of the US population from 2012 through 2020, the percentage reporting up to date with CRC screening has increased, but not equally among all subgroups.

Colorectal Cancer Screening Among Adults in Zuni Pueblo: Factors Associated with FOBT and Colonoscopy Utilization.

Although strategies to mitigate barriers to colorectal cancer (CRC) screening have proven successful in some parts of the US, few of these strategies have been studied in rural, American Indian communities that may exhibit unique culturally driven attitudes toward and knowledge of colorectal cancer and experience increased barriers to healthcare access. In this study, we describe the results of a survey among CRC screen-eligible members of Zuni Pueblo (N = 218) on an array of questions regarding CRC screening behaviors, knowledge, satisfaction with and access to healthcare services, social support for CRC screening, perceptions toward FOBT, and preference for evidence-based interventions or strategies for improving CRC screening rates. Results from the multivariable model suggest age, having a regular healthcare provider, and harboring fewer negative perceptions toward FOBT are key drivers of ever completing CRC screening. Respondents reported strong support for Community Guide-recommended interventions and strategies for increasing CRC screening for nearly all proposed interventions. Results confirm the need for multilevel, multicomponent interventions, with a particular focus on improving Zuni Pueblo community members' access to a regular source of care, improving knowledge of CRC risk factor, and addressing negative perceptions toward CRC screening. These results provide critical, community-specific insight into better understanding the drivers of low guideline-adherent screening rates and inform local healthcare providers and community leaders of context-specific strategies to improve CRC screening in Zuni Pueblo.

Heterogeneity in the Utilization of Fecal Occult Blood Testing and Colonoscopy among Migrants and Non-Migrants in Austria: Results of the Austrian Health Interview Survey

Many European studies report lower participation in colorectal cancer screening among migrants than non-migrants. A major limitation of these studies is that usually, the heterogeneity of migrants cannot be accounted for. The aim of this investigation was to examine differences in the utilization of fecal occult blood testing and colonoscopy between non-migrants and the five largest migrant groups residing in Austria using data from the Austrian Health Interview Survey 2019. The two outcomes were compared between non-migrants and migrants using multivariable logistic regression adjusted for socioeconomic and health variables. Migrants from a Yugoslav successor state (OR = 0.61; 95%-CI: 0.44–0.83), Turkish (OR = 0.35; 95%-CI: 0.22–0.55), Hungarian (OR = 0.37; 95%-CI: 0.16–0.82) and German migrants (OR = 0.70; 95%-CI: 0.51–0.98) were less likely to have used a fecal occult blood test compared to non-migrants. Participation in colonoscopy was lower among Turkish migrants (OR = 0.42; 95%-CI: 0.27–0.67) and migrants from a Yugoslav successor state (OR = 0.56; 95%-CI: 0.42–0.75) than among non-migrants. The findings are consistent with studies from other countries and highlight barriers migrants face in accessing the health care system. To address these barriers, the heterogeneity of the population must be taken into account when developing educational materials in order to promote informed decisions about whether or not to participate in colorectal cancer screening.

Utility of repeat colonoscopy within 1 year: a patient-level analysis

Patients undergo colonoscopies for colorectal cancer screening and for the evaluation of gastrointestinal symptoms. Analysis of large administrative databases has demonstrated that some patients undergo repeat colonoscopies at intervals inconsistent with current recommendations, but these studies do not provide patient-level details. The medical records of 110 patients undergoing repeat colonoscopies within 1 year of their index colonoscopies at a tertiary care hospital-based endoscopy center were retrospectively reviewed to determine patient demographics, gastrointestinal symptoms, and endoscopic findings. Thirty-five patients had poor bowel preparations, and 11 patients had a history of colorectal cancer. Thirty-four patients had polyps identified during their index colonoscopies, and 28 patients had no polyps identified during their index colonoscopies. Eleven patients in the nonpolyp group had new endoscopic findings identified during the repeat colonoscopies. Twenty patients who had polyps identified on their index colonoscopies had 44 polyps identified on repeat colonoscopies. Repeat colonoscopies within 1 year occurred relatively infrequently in this endoscopy center. Indications included poor bowel preparation with incomplete studies, colonic polyps with incomplete resection, multiple polyps resulting in the possibility of missed polyps, and new gastrointestinal symptoms.

Abstract A100: Associations of multiple chronic conditions and colonoscopy utilization among different race/ethnic groups: BRFSS 2012-2020

Abstract Background: Colorectal cancer (CRC) is the 4th most commonly diagnosed cancer and the 4th cause of cancer-related death in the U.S. Early detection of CRC through routine screening has been associated with decreasing CRC mortality. Because many chronic conditions share risk factors with CRC, the importance of CRC screening in adults with multiple chronic conditions (MCC) is increased as those with MCC are at higher risk of developing CRC. This study examines the association of number and types of chronic conditions (individual, dyads, and triads) with the receipt of colonoscopy and whether this association differs across race/ethnic groups. Methods: We conducted a cross-sectional analysis of 976,467 adults aged 50-74 years in the US Behavioral Risk Factor Surveillance System (2012-2020). Self-reported receipt of last/most recent colonoscopy was categorized as never, &amp;lt;10 years and ≥10 years. MCC was calculated using counts of 12 chronic conditions (obesity, arthritis, diabetes, smoking, depression, binge drinking, cardiovascular diseases (CVD), asthma, chronic obstructive pulmonary disease (COPD), kidney disease, cancer, skin cancer) and categorized as none, 1, 2, ≥3 conditions. The most common chronic condition dyads and triads were assessed. A logistic model was used to quantify the association between MCC and the receipt of colonoscopy adjusted for sex, age, and health care insurance status; additional analyses were stratified by race/ethnicity. All results were weighted to be representative of the broader population of U.S. adults aged 50 – 74 years using standard BRFSS weights. Results: Over half the sample were women (52.5%), 72.4% non-Hispanic white, and 62.8% had a colonoscopy in previous 10 years. Nearly one-third had ≥3 MCC (32.6%) and 23.1% had two MCC. Participants with ≥3 MCC were more likely to have had a colonoscopy in ≤10 years (adjusted odds ratio [aOR]: 1.28; 95% confidence interval [CI]: 1.24–1.32) than those without MCCs, regardless of race/ethnicity. Participants with the triad of smoking, binge drinking, and CVD were less likely to have had a colonoscopy within 10 years (aOR: 0.65; 95%CI: 0.54–0.78) than those without this MCC triad. The association between different combinations of MCC and colonoscopy utilization varied by race/ethnicity. Among those with the smoking/binge drinking/CVD triad, non-Hispanic Blacks (aOR: 0.59; 95%CI: 0.39–0.90) and US Hispanics (aOR: 0.28; 95%CI: 0.10–0.74) participants were less likely to have had a colonoscopy within 10 years than participants without this triad and identified with the same race/ethnic group. Conclusion: MCCs are common among adults aged 50-74 years. The MCC triad of smoking, binge drinking, and CVD was associated with a lack of colonoscopy adherence recommendation, and adults identified as non-Hispanic Blacks and US Hispanics with this triad were even less likely to receive a colonoscopy within 10 years. This finding may help health care providers and systems to identify patients at higher risk of CRC and non-adherent to cancer screening recommendations. Citation Format: Maira A. Castaneda-Avila, Mara M. Epstein, Mayra Tisminetzky, Atinuke G. Oyinbo, Kate L. Lapane. Associations of multiple chronic conditions and colonoscopy utilization among different race/ethnic groups: BRFSS 2012-2020 [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr A100.

Utility of early colonoscopy for acute lower gastrointestinal bleeding: a retrospective cohort study.

Early colonoscopy (within 8-24 h) is recommended in different guidelines for acute lower gastrointestinal bleeding (LGIB). Despite this recommendation, evidence for its effectiveness are conflicting, and early colonoscopy is often not performed. We aimed to evaluate the utility of early colonoscopy by examining the findings during the procedure, and by comparing in-hospital and long-term outcomes between patients who did and did not undergo early colonoscopy. This is a retrospective cohort study based on the electronic medical records of a large tertiary hospital in Israel. All patients hospitalized with acute LGIB to acute wards between 2012 and 2022 were included. First, structured and free-text procedure notes from patients who did undergo early colonoscopy were examined. Second, we compared in-hospital and long-term outcomes between patients who did and did not undergo early colonoscopy while adjusting for possible confounders using multivariable regression of the type appropriate for each outcome. Overall, 953 patients were included, of which 90 underwent early colonoscopy. The majority (54%) were found insufficiently prepared. Common findings were diverticulosis (38%) and colon polyps (20%). The procedure was effective for hemostasis in only 13% of the cases. Early colonoscopy was not significantly associated with increased survival (exponentiated coefficient = 1.19, 95% CI: 0.76, 1.87), decreased length of hospitalization (exponentiated coefficient = 1.08, 95% CI: 0.97, 1.21), or increased blood hemoglobin at discharge (coefficient =-0.27, 95% CI: -0.58, 0.03). Early colonoscopy was often not effective and was not associated with significantly improved outcomes.

S628 Disparities in Colonoscopy Utilization After the COVID-19 Pandemic

Introduction: In the first 3 months of the COVID-19 pandemic, our institution in San Francisco like many others limited routine elective procedures which resulted in a stark decline in endoscopy volume. There is concern that despite returning to pre-pandemic colonoscopy rates in the recovery period, these procedural delays may have had a lasting impact and worsened preexisting disparities in access to endoscopy. We aim to examine disparities in colonoscopy utilization in the post COVID-19 era as compared to the pre-pandemic period. Methods: We included all adult patients who underwent outpatient colonoscopy at our institution in the following time periods: (1) 7/1/17 to 3/15/20 (“pre-COVID”) and (2) 3/16/20 to 11/30/21 (“post-COVID”). We abstracted age, gender, race, language preference, insurance type and income quartile by zip code from the medical record. We identified those that were “high risk” for CRC based on personal or family history. Multivariable logistic regression analysis was performed to assess the association between subject characteristics and colonoscopy exposure in the post-COVID era. (Table) Results: There were 14,381 and 10,376 colonoscopies included in pre and post-COVID periods respectively. English-speaking patients comprised 92.8% of the pre-COVID cohort which increased to 94.2% in the post-COVID era (p < .001). This difference was statistically significant on multivariable analysis (OR 1.63, 95% CI 1.09-2.42). While there was also a statistically significant increase in colonoscopies of patients who identify as LatinX compared to white race (OR 1.14, 95% CI 1.03-1.26), the magnitude of this change was small – 8.3% versus 9.2% in the pre and post-COVID cohorts. We found an inverse association between the post-COVID era and Medicare insurance status as compared to private insurance (OR 0.87, 95% CI 0.81-0.95). There were no significant associations on multivariable analysis between colonoscopy in the post COVID phase and age, gender, race, income quartile by zip code nor high-risk status. Conclusion: In the aftermath of COVID-19 and after colonoscopy volume had returned to pre-pandemic levels, there was a reduction in colonoscopy utilization by non-English speakers as well as patients with Medicare insurance. Reassuringly, it does not appear that the well-established pre-existing racial gap in colonoscopy access was worsened by the COVID 19 pandemic in our population nor was there a material difference in colonoscopy use by income quartile – a common measure of socioeconomic disparity. Table 1. - Multivariable Logistic Regression of Attributes Associated with Colonoscopy Utilization in the post-COVID era (March 16, 2020 - November 30, 2021) compared to pre-COVID (July 1, 2017 - March 15, 2020) Odds Ratio 95% CI p-value Age < 45 1.05 0.98-1.12 0.21 45-59 1.0 - - 60-69 0.92 0.86-0.99 0.03 70-79 1.03 0.93-1.14 0.58 >80 1.22 1.01-1.47 0.04 Female 1.05 1.00-1.11 0.05 Race White 1.0 - - Black 1.11 0.99-1.25 0.07 Asian 1.01 0.94-1.09 0.77 Latinx 1.14 1.03-1.26 < 0.01 Other 1.004 0.90-1.12 0.95 Language English 1.0 - - Spanish 0.70 0.44-1.12 0.14 Russian 0.59 0.38-0.93 0.02 Chinese Dialects 0.55 0.36-0.84 < 0.01 Other 0.66 0.43-1.01 0.054 English v. All Others 1.63 1.09-2.42 0.02 Insurance Private 1.0 - - Medicare 0.87 0.81-0.95 < 0.01 Medical/Covered CA 0.95 0.87-1.02 0.16 Income Highest Quartile 1 - - 2nd Quartile 0.88 0.39-1.97 0.76 3rd Quartile 0.83 0.37-1.85 0.65 4th Quartile 0.80 0.36-1.80 0.59 High Risk 0.95 0.90-1.00 0.05